Until recently, osteoporosis, a known health risk in postmenopausal women, has attracted scant attention as a health risk for men.

"Perhaps, despite perceptions to the contrary, men lose bone at about the same rate as women do," said Eric Orwoll, MD, Professor of Medicine at Oregon Health & Science University in Portland, speaking at the 26th Annual Meeting of the American Society for Bone and Mineral Research (ASBMR) in Seattle. One study that highlights gender equivalent risks of age-related bone loss in the femoral neck showed rates of 0.4% for men and 0.6% for women over a 5-year interval.¹

Although men and women alike benefit from treatment for osteoporosis, men receive treatment far less frequently, even after fractures. "For reasons that are not entirely clear, osteoporosis in men isn't treated as aggressively as it is in women," said Dr. Orwoll. "There is a gap in the application of evidence-based medicine and physicians are missing a real opportunity to help patients who could benefit from treatment."

A recent study reported by Orwoll's team showed that only 4.5% of men were receiving treatment at hospital discharge after atraumatic hip fractures, as compared to 27% of women who received treatment. Five years later, only 27% of men vs 71% of women were being treated.²

Another study reported by his group at the ASBMR meeting corroborated the earlier results. The study assessed treatment in 1171 older men 6 months after hospital discharge for any new osteoporotic fracture. The analysis showed that only 7.1% of the men received treatment, and the rate did not increase with additional follow-up.³

Low rates of treatment among male patients occur despite compelling evidence that men can benefit from treatments that improve bone mineral density (BMD) in women with osteoporosis. For example, in a 2-year double-blind trial, men with osteoporosis who were treated with a bisphosphonate and calcium and vitamin D supplements demonstrated increased BMD and lower incidence of vertebral fracture.^4,5

A study reported at the ASBMR meeting showed that declining BMD correlates with increasing risk for all nonvertebral fractures.⁶ A previous study showed that the risk of vertebral fracture rises sharply with age in both men and women.⁷ Men's high risk for subsequent fractures after experiencing hip fracture has also been shown previously.⁸

Risk factors for osteoporosis are similar in men and women and include older age, a history of falls, low body weight, calcium and vitamin D insufficiency, and smoking. Dr. Orwoll suggested that physicians should consider screening for osteoporosis in selected male patients, including those with a history of low-trauma fracture, vertebral deformity, any risk factors for osteoporosis, or radiographic evidence of osteoporosis. "If a patient appears at increased risk, the threshold for screening should be low," he said.

References

1. Burger H, de Laet CE, van Daele PL, et al. Risk factors for increased bone loss in an elderly population: the Rotterdam Study. Am J Epidemiol. 1998;147:871-879.

2. Kiebzak GM, Beinart GA, Perser K, et al. Undertreatment of osteoporosis in men with hip fracture. Arch Intern Med. 2002;162:2217-2222.

3. J Bone Miner Res. 2004;19(suppl 1):S30. Abstract 1113.

4. Orwoll E, Ettinger M, Weiss S, et al. Alendronate for the treatment of osteoporosis in men. N Engl J Med. 2000;343:604-610.

5. Adachi JD, Bensen WG, Brown J, et al. Intermittent etidronate therapy to prevent corticosteroid-induced osteoporosis. N Engl J Med. 1997;337:382-387.

6. J Bone Miner Res. 2004;19(suppl 1):S4. Abstract 1009.

7. Cooper C, Atkinson EJ, O'Fallon WM, Melton LJ 3rd. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-1989. J Bone Miner Res. 1992;7:221-227.

8. Colon-Emeric CS, Sloane R, Hawkes WG, et al. The risk of subsequent fractures in community-dwelling men and male veterans with hip fracture. Am J Med. 2000;109:324-326.